Archive for December 2013 | Monthly archive page

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USC Campus
Dr. Daniel Vinograd has established a long and prosperous career as the dentist San Diego prefers, because of his holistic, pain-free and biocompatible approach to dentistry. What you may not know is that he has a longstanding relationship with his alma mater, the University of Southern California.

Today, he’s a professor of dentistry for the university where he received his DDS degree.

USC is a private university founded in 1880 and based in Los Angeles. It’s the oldest private research institution of higher learning in California, trains a large number of international students and fully embraces its close proximity to Hollywood. It’s also consistently rated as one of the top colleges in the nation.

Here’s a bit of trivia that makes dentists like Dr. Vinograd proud: USC’s well-regarded fight song “Fight On” was composed by dental student Milo Sweet in 1922 — although Glen Grant has to be given partial credit for the lyrics.

Even if you’ve never been on the USC campus, you’ve probably seen it. That’s because its location means it features prominently on film and on television. You may have seen it in Forrest Gump, Ghostbusters, The Social Network or The Graduate. You may have also seen it on The Fresh Prince of Bel-Air, House MD, The Office or Monk, to name only a few of the many TV series that have filmed on the campus. Even Wheel of Fortune and Jeopardy have shot there.

The University of Southern California’s close relationship with Hollywood and pop culture doesn’t mean it takes its professional programs less seriously. If you think about it, good teeth are an important part of any Hollywood career, and quite a number of the entertainment industry’s top names depend on USC dental school graduates for their award-winning smiles.

Will you be the next to turn to the San Diego dentist citizens of all types entrust with their precious teeth? Getting started is as easy as setting up an appointment.

 

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Not really concerned what brand of toothpaste you buy? Not interested in making your own toothpaste when you can buy one at the store that works pretty well?

Perhaps the best reason of all for making toothpaste at home, or carefully choosing what brand you use, is avoiding SLS. But what is SLS and why is it so bad? Keep reading and you’ll understand.

Getting To Know SLS

Sodium Lauryl Sulfate or SLS is found a lot of personal care products. But it doesn’t really belong there. In fact, putting it there doesn’t make much sense at all.

While it serves as a surfactant — a substance that breaks surface tension so a product can penetrate — it can cause skin irritation, the worsening of skin problems and other issues. Even worse, some people have an allergy to it, causing even more severe adverse reactions. And still worse yet, it can cause canker sores — those round white sores in your mouth that sting for days — and can cause dry mouth.

If you have a problem with skin issues, canker sores or dry mouth, you need to eliminate SLS from your toothpaste and from your other skin, mouth and healthcare products. Doing so could eliminate your problems or at least make them not as bad. In fact, research has proven a decrease in canker sores when using an SLS-free toothpaste.

If You Love Food…

Perhaps worst yet if you’re a foodie, SLS in toothpaste has been shown in one study to cause a temporary alteration in your ability to taste. Have you ever noticed that food tastes strange if you eat immediately after brushing your teeth? SLS could be the reason.

The reason this issue isn’t talked about more is that most people intentionally avoid eating after brushing their teeth to keep their teeth clean, so they may not necessarily notice this side effect.

Simply put, avoid SLS at all cost to avoid its side effects for a healthier and better life.

For a great  homemade toothpaste recipe without SLS, visit: http://homemadetoothpaste.net

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I want to share with you this case. Many of you may know this guy Lenny LeBlanc. He is a recording artiste and song writer. Back in 1977 Lenya had a fabulous hit ‘falling ‘ and doing the time he has converted over as a Christian arties. One of is some that’s just a mega hit is “above all”. Perhaps you have herd that Lenny is an outstanding arties. We have many song  writers and recording arties that live in  our area because of Fame studio and several of them arte actually my patient  and penny is one of our best  His new CD  has  Fallen on it ,  it’s total of it is Love like no other. Lenny recently did a benefit concert here in the area and we see Lenny, myself, my wife and our staff and this was a fundraiser benefit for underprivileged children in the area but anyway we just finished jay new smile o penny. This what he did  look like and  I notice nan a lot  of his photographs early on  that he just didn’t smile for his  album  so he wanted to do something  about it.

 

We did   one single crown and some veneers and tried to rebuild his smile. We made his teeth a little bit exaggerated because of his stage presence. We checked him on stage to see what it would like and this gave us good results .Now we’re about to get started on a lower on Lenny and he’s just a wonderful guy and based on his song Fallen we ‘eve done all of your marketing on Falling in love with your smile and we use Lenny’s song in a lot of out advertising and promotions.

 

Laser bleaching

One good thing about the easy lays is that it has a belching wand that comes with it and you can bleach a quadrant of teeth at a time. It’s a very short cycle and it does a great job. The system is just wonder foul and the appointment is about a one hour appointment with outstanding results. You see untouched photos of before and an immediate one hour after. very good results for your patients.

 

Let’s talk briefly about Period. Very exciting things are happening in the laser world relative to period and mechanical treatments such as [Inaudible] are not able to remove bacteria .Its just no longer enough. The thing we have to contend with in period is of course bacteria, the bio fame we have to be able to get rid of the snot inside   of the gums. It’s just a horrible collection of  microbial matrix there and we want to get rid  of it , There’s  plaque attached to the tooth , there’s unattached  plaque , there is epithelia plaque . Plaque are bacteria and the connected tissue and bacteria on the bone surface. We are dealing with a lot of bacteria so we will like to get rid of the bacteria in the area around the tooth. The pocket therapy with resulting new attachment thanks to the radula fire peril tips.

 

I know we talked about radial fire tips in indo and this tip is similar but again it is different. The thing that’s different again about that is you will notice that the end of the tip is blunted slightly and the sides are bebble. This allows about 60% of the energy to come out the side so that we can depothilize the lining of the pocket and remove calculus and about 40% comes out the end so that we can reach the bottom of the pocket and we can interact with the bone if necessary.

 

This is a really neat tip and these have been out a little before the first of the years and we are getting great results with them. This is techniques. You see the radio fire tip here in the photograph and we use it first and foremost for trapping to open it up a little bit and to remove the inner epithermal lining. The radio fire tip goes to the side and to the bottom of the pocket towards the tooth and then we can turn the tip slightly towards the tooth and actually remove calculus form the trot surface. When we are doing I’m always seeing little bit of calculus foot up and come to the surface and this is after they have been through root plaguing and scaling. There is always that little bit that you did not get.

 

In here in the photograph you see a piece of calculus that came out right after we used the laser. This is way the tip looks going into the pocket. Once we’ve done the pocket itself we’ll move outside to the outer epithelium to remove it and this is what that would look like. Here’s the reason for that. As we  go down and  we depethalize the lining of the  pocket  and heal it  quad clean the side of the tooth  the healing process begins , the epelthial cells from here will grow much more rapidly than the functional  epithelium down in the bottom of the pocket . Remember err we are trying to establish reattachment.

 

In order to be of service to the functional epithelium don here we take the epethialnn cells here and move them back away from the starting line. We make them run further. They  arte going to grow faster so  we make them go father and so we  remove that outer epetelhelium and then about a week later we go back and  do the same thing and grab those  cells and take them back to the starting line again to give the junction  epithelium more time  for reattachment . After we do that we just apple pressure for about 5 minutes to get a really good broadcloth and then we apply derma bond, a sisal to seal up and this is what it looks like immediately post opposite.

 

A far cry from bridal peril surgery where we would have made the incision, we would have a lot of bleeding and we would have sutures showing and peril dressing. We are really proud of this case. This is one that we just recently worked none. This is the way that the patient present it to our office. A portion of the metal crown on number 9, some obvious periodontal problems and association with that. You see the lingual side. Graphically it looks  like  this. We plan to get the patient in for treatment but before the patient can actually commence she presented with this, an obvious perio abyss. Things are just not going well where. This is the radiograph, you can see the obvious bone loss around the tooth and these were the measurements a collection of 5, 6, 7, and 8s. So not a good situation. We did the procedure that we just described with the laser. Here you see the radio fire perio tip and one week later it definitely looked better. The day what we did the procedure w definitely went in and adjusted the avulsion not the lingual side of those tooth that was in traumatic inclusion. Four weeks later it look  like this and at that point in time we took a whole portion  of the metal cram and we fabricated a  temporary cram to go on it and three months later it looks like this .A huge noticeable improvement and all we’ve  done  here was the laser procedure with the radio fire perio tip and look at our new measurements, I’m not exaggerating  , I use   the same force in making this measurements that we did the first  stage when she came in and we got the 5,6, 7, an and 8s. She was down to 2s and 3s all the way this tooth, just a reachable   improvement over a three month period.

 

 

Three months post operatively radio graphically she looks like this and in my opinion I t think we are beginning to see bone formation in them and so bone growth in that area. If you go back and compare it to April of this year and you look at the same area I think you would have to agree things looks considerable   better in there. We had  plan to  do  dome surgery and a graph  but quite  honestly at this point we were juts allowing  thinks to just go along  because she is doing so well and  if  things continue it  will be a permanent  cram in the near future.

 

Now in the last couple of segments want to talk about profitability with lasers. If you are going tom make an investment like this I think you need to think seriously about hats it’s going to do for my practise and what’s the return on investment. I think that’s a very fair question. First of all we are going to look at the smaller picture procedure by procedure but it really does mouton up fast. Let’s look first of all at additional procedures.  Things that you are currently doing but you can do a few more of those because of laser dentistry.

 

Let’s take the several 750 000 per year dental practise and let’s say that because of the laser faster procedures we can do additional restorative procedures two per day. Well how can you do that? Bomber obey we are working without anaesthesia so we don’t have that wait time .We can work in multiple quadrants instead of limiting ourselves to just one quadrant. There are many times that patients come  in and I fill number 3, 4 , 19 and 30  all in one appointment and I centrally  wouldn’t do that if I had to do that   with anaesthesia. By deign two extra per day we can add $64 400 to this practise.

 

Proteomes and restoration, because we can do proteomes in one step without for more. If we could add one per week, one additional per week we can add $19 750 to this practise. An additional surgical extraction remember we talked about being able to do surgical extraction without having to lay a flap and remove bone. If we could add two of these per week we could add $27 900 to this practise.

 

Additional cosmetic veneer because f of the way we are able to do destroy and that wonderful help that  a laser is in our soft  tissue around our cosmetic work let’s say we can  just  do one , one extra peer week we could  add 74 750 to this  practise . Then by doing biopsies. Remember if you have a solution you see the problem and I told   you we do a lot of biopsies because we are looking or things that need to be checked.  If we can just add one per week we can add $23 350 to this practise.  All  together additional procedures, things that we are currently  doing  but we are  just  going to do a few more of them than we have in the past  because of the laser , we could add $210 150 to this practise.

 

Now let’s look at new procedures. Remember we sort of addressed them in the beginning. Let’s not just send them out the door.  I know that I have to use the specialist too and they are e things that we defiantly need to send to the specialist but they are   many very basic procedures that we send out that we can keep in house. Again the $750 000 practise. If h you are  not currently  doing phrenecotmy  and tongue tie releases  remember I told  you earlier that only  5% of the dentist out there  routinely do these procedures .  If you just add one per week you could add $23 550 to this practise.

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Tongue tie release, remember every day, every way you will see some one occasionally that is tongue tied if you are looking for them if you have a solution to this   problem. When the patient raises their tongue we get the classic valentine shape there and they can’t stick their tongue out very far past their lip. This is a very simple procedure. Its lingual phrenectomy. You place haemostats at the base of the tongue and then we cut on the side ops at the haemostat then we go back about 3/4 of an inch to an inch to release.

 

 

Then you let the patient move their tongue around and see if they can touch the roof of their mouth and of they can extend it out past their lip now and when you have gone back as far back as far as you thin you need to go then you can place your sutures. It is very important in this case to make sure… I ideally place 3 sutures so that you do not get any reattachment.

 

Here’s a very large mucus seal. I’m sure there are days that people come in your office and you see a mucus seal. If you’ve taken one out you know that they can be a little   not hard to determine the borders so this one was incised using the laser. Again very little bleeding. Look at the size of this, very large mucus seal. Seven days later wonderful healing and I want you to notice something in the pathology report. Yes it was a mucus seal but look lateral and deep margins are   free of legions indicating complete excision. That means we’ve gotten on there and we’ve got out there with the laser and we remove the mucus seal in total.

 

Ovate ponits

This lady now have a really beautiful smile. It didn’t look that way just prior to the bridge she has. It looked like this. For quite some time we encouraged her to take out the f tooth in the frond and consider doing a bridge so we took the teeth h out and to give us a better look we use the chisel   tip of the laser to ovate our ponic size all the way   cross to the front, we use the double embossment t on each side. This gave use little bit better, a little bit natural look for this patient and age her a prettier smile. Now she is interested in doing the remaining teeth in her mouth.

 

Every day dentist y certainly includes crowning bridge j and it includes eight packing chord or using a laser to trop around crown grips. We use the Easy Lays 9400, it’s wonderful. It has disposable tips instead of having to clean the fibre of the tops you can just use once and then throw them away. Here is a lower full mouth case where we would have to pack a lot of cord yet we didn’t pack a single cord. In fact we don’t have any cord in my oppotuires, we never use any cord.

 

It allowed us to make a nice impression and get good results with our rotation. For asius  procedures, surgical extraction  assert notes that for time to time  your face with a case like this and sometimes we have to consider  laying a flap and removing some  bone to get a broken root like this  out.  With laser we can use this 400, 5000 or 600 micron tip, Boa Lays have a nice selection of tips. The longer ones work really well or this. We can go down around  the root and break the attachment  between the period ligament  in the bone and the tooth and then we can either with  forceps  or  with thin elevators , peritonea, elevate  the tooth out of the socket without having to lay  a flap .

 

Just another example of this  I really think you  will be quick  to admit if this walked   in your office you’re going to be thing in about laying a flap and you’re going to be thinking about removing some  bones. Look at the bone   levels on this .The tooth is us all the way down to the bone yet we still have a full sized root. Yet we were able to go in with a laser an uncover it and elevate it out without flap. That also works out very nicely if you’re going to do an immediate implant placement. Here’s a surgical extraction with the root amputation, a rather unusual case is a bridge on the upper right.

 

We notice on the radiographic examination that distal buckle root had been severed from the tooth, [Inaudible] decay and so we went in with the laser and just took the root out into having to lay a flap and this is the way it looked immodestly postoperative. A few weeks later we actually went back and actually used this second molar as a bridge abutment with just a medium buckle and the powerful roots. You can see it radigraphically and excuse the blood in the field but this is right after we cemented   it in and cleared around it.

 

Now we got   a nice bridge abutment without having to have out r patient have to have an implant or other processes there. An apical granuloma, between x-rays we found this root tip left behind, granuloma tissue around it. Incision with the laser, open up the window with the laser, clean out the area, palace some bone graph material and here it is   BS shortly after that. I think this was one week later, on week or ten days later. Olio surgery with the graph, this particular tooth had to have indo. It had really low  decay  here to the media and we had to open it up  and do a little bone  crack in he are , re contour the bone just a little bit . All one with the laser. You can see after indo was done a build-up will material will be forward on the tooth because that’s where the decay when originally.

 

Here it  is about  6 months lather and here you can  see the restoration that we were able to  place  so we were  able to keep the tooth by moving the bone level back , doing a little bone graphing in this  area and it gave us great results.

 

 

Crown lengthening

In this particcualr case we will take it all the way though, you can see that we are in a cross bite here, interior open by a low tissue line on the literal insider and   this later insider is wearied out.  Just make a mark with the sharpie to see where we want to move the tissue line, move it back with the Boa Lays laser and then use the chisel tips for recon touring the tissue. Once we establish our tissue lien when we want to move the bone up so that we have 3, boiologiocicl width. When I say we do this flapless we use a gold pirate   and we actually will go, well it doesn’t actually show in the picture but we will retract the tissue back a little bit so that we can actually see the bone underneath there so we are not on tally working blind but it does allow is not to disturb the filling on either side of the tooth and maintain a nice sharp point there. Just clean   it up with the pirate and we apply a title l pressure, use ox fires gel, eye it applied here and I think this was one week later. We did not disturb the lingual side and a few weeks later we did our preps for 360 porcelain, we chopped with the dial wood laser, our temporaries are in place ad ten the finish product. We’ve got a nice height on our later incisor, we corrected the cross bite, we closed up the bite in the front so here’s your before and after. Lasers   were very much an important part of this and we wound up with some beautiful results on this overly  patient.

 

Crown Lengthen Open flap  this is a case  where we had a three unit bridge , the  patient had a decay  underneath  the [Inaudible] , it was just completely decayed  out from under the abutment so we had to make  an decision  here and we decided  to do indo and a build-up pan  it and then we reflected a flap and removed  some bones so we could crowd lengthen and continue  to use this as abutment.

 

Here is immediately post-operative. One week post opt and six weeks post up > we have great healing, we now have a biological width sufficient that we can put a crown. Now we will go back and remove the other abutment bad sod a new bridge for this patient. we had done some  interior corn work  and we won’t doo the back cupids but  as you can see the tissue line dips  way down so in other to keep a good look  we wanted to move the tissue up a little bit and so  we dotted it with a Boa laser  move the tissue back to the  new line we waited to open flap and then by using weather 400 to 600 micron  tip and then with  chisel tip we were able to move the  bone back and then after 6 weeks healing we can go  back in and do our restorations and get a more pleasing tissue line .

 

Cosmetics, this is a new brochure we have in our office that we hand out to our patients. I just want to introduce you to some of our patients that have fallen in love with their smile. I will explain that later. I don’t have any  prompts I on this lady on my PowerPoint but you can see  and all  of cosmetics we have done some tissue reocontouring , tissue touch up before we  place their porcelain work . This is a case and a very beautiful last. Preoptivlely she had some dark stain, discoloured teeth. She just wanted that to have a better look. There’s minimal prep veneers to help cover pup the dark staining and you can see out r end result. She was very please.  Pictures of those case e will actually be in the LBI magazine this fall.

 

 

This is a great patient, a wonderful person that we just did a full mouth reconstruction and the laser played a big part of that. This is his bite. He actually does have lower teeth here, he just have an extreme over bit it’s what the lower look like and the upper. Actually tooth number 29 was fractured and we just decided too cut it done with a laser and do some mat and like a retro field except from the inclusion and put the tooth to sleep and let it stay in there rather than try to take it out. You can see that that the root remains underneath there. Also in the interior you just  really dint have anything  to support crown so we had to g o in and crown lengthen his teeth across the front t with the laser and here you can see immediately after  we upper with his temporary [Inaudible]  and  on the upper  there  was someone teeth we just couldn’t save , we had to take them out , we had to do some crown  lengthen then we were able to open  up his  bite. For once in his life in a long, long time   he was able to see that he had teeth in his mount and when he smiled folks knew that he had teeth.

 

Up until then you really couldn’t tell that he had any   teeth at all. So good patient, great case thanks to the lasers. One final case along that line is just there’s some great results from an interior aesthetic stand point with six porcelain crowns to restore smile for this excellent patient of ours, this wonderful guy. Now he is ready to do the lower and currently we have had to crown lengthen this tooth after we did indo on it so we are working on this case as we speak now.

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Pulp autonomies can now be done without having to use former, to be opened up and be treated with the laser, dropped inside of the pulp chamber with the laser. We use a little MTA on top of that and then go ahead and place our restoration.  When we talk about indo terbium chromium YSTG laser uses the radial firing tips and they are much provisioned for removing bacteria form the root canal system and also removal of the smear layer. As you can see on this photograph look at the dental tubes they’re wide open.  15% of root canals   that GPs do each year require retreatment and generally it’s because of reinfection. 99.7% reduction in bacteria count is when a canal is sterilised with a laser.

 

The radio fire tips as you see into his photograph here have a unique being because of the angle on the tip it disperses the energy laterally at an angle and if you notice it comes to a very exact point. When the tip comes to a point like that no energy is omitted thrush the end of the top. At this case we do want it to go laterally. If it goes out the end it ocean gout the end of the root ad stimulate some apical bleeding.

 

Here you see  an indo tip , one that’s a brand new one  and one that’s been used one too many times. As you can see in the photograph it’s blunted and if we use one too long and it becomes too blunted like this then the energy can travel out the end of the tip, out the end of the root of the tooth and cause an apical bleeding.  There are two different sized tips at 200 and 300 micron they fit east [toy down inside the canals. Here you see a tip in use and we can set working length by the rubber stop that you see on the tip.

 

Down on the canal you admit their energy on the way out to remove the smear layer and to get rid of any bacteria that may be present. When we look down in the canal after that   this is what we see.  You will see that the canal are really frosted looking, very clean and a wonderful environment. It gives us a better seal between the [Inaudible] and the tooth. We can actually open the tooth up for indo using the laser if we need to. Other times if it’s a really hot tooth and you go in with your hand piece you know that the vibration that you get from hand piece, woven though you have good anaesthesia the patients still feels it. If you have a really hot tooth like that one of the best thing you can do is to open the tooth and get you access with you laser.

 

We use conventional instrumentation after that and then we turn to the laser for cleaning. It removes the smear layer, only takes about 2-3 minutes and also we get micro agitation tip to help clean out the cancel. From this photograph you can see with the laser it in water as laser energy has admitted it, it cause bubbles and squeezes down inside the canal. I see little particles falling out all the time as it cleans. It does a wonderful job of cleaning the root canal system. Then we can turn to the laser drive for disinfection. It reaches out into the dental canals and destroys the hidden bacteria that might there. Reamer we are using a radio fire tip.

 

Let’s talk just briefly and give another examine of another thing we can use the laser for and in endeavonance for an apectomy. Teeth  9 and 10 and on the radiograph we see a rather large  lesion inn association  with the apices  of 9 and 0 and  in  kHz radio graph you can see  that  we’ve complete the indo  on both of those two teeth . We just measure up from the incision edge to locate the approximate apex of that teeth and we will make out incision using the laser. Once we have the incision and woe open up the indoor of the bone using the same laser tip and then once the window is complete us clean out the legion area and wee amputate the apex with a little slight beble for access.

 

After we do that we can use   the laser to go to the end of the root of the teeth and take out the gutter putura or the material it might be using at the very end and then we can do a retriivabatye field using MTA. Following that we can use a brine graph, seek though the area and then we are finished. With the laser we’ve made our access with an incision, we’ve amputate the root, we’ve opened up the root at the end of the tooth. It’s just a great tool and here you eel postoperatively our legion as it started and post operatively here is the lesion after we did the apical.

 

This is one week later, six week later and 12 months later. One thing that I mention about this  particcualr case is that this  patient  was an extreme diabetic so  healing was even compromised by that  fact and I think you can tell that we got wonderful healing in this case.

 

Now let’s talk a little bit abs tout soft tissue. The treatment of a respective legation, we could also use the same treatment for an after ulcer.  you want to get to the legion  why it is still in the vesicular state  before  it gets into the vesicular  stage , when the  patient can first feel   it coming on this time to treat it .We treat the herpetic legion with the laser. We just fire around the outside and   work our way to the centre covering all of it. We want to be sure when you do a good high volume suctions system and one of the better quality mass.

 

You can also treat an after sulphur inside the mouth with the sane techniques. We do quite a few biopsies in our offices. This a biopsies for the removal of a fibroid, it’s a very large none. We use soft tissue   pick up forceps and soft tissue tip on the laser and an incision to remove the entire fireman and after tan we use chisel tip to go back and do the laser band aid. It says here to put a little oxy fresh gel on top of the legion and here it is 6 days post operatively.

 

One of the things that you see with the laser is that healing is just wonderful after using a laser, much better   than if you use a blade or an electro surge. By the way the patient that you saw in the photograph here was 86 years old at the time this was done so I think that was pretty good healing for someone off that age. A Paloma on  the tongue , again using soft  tissue pick  up forces and soft issue tips on the  laser , we just go around and remove that and if you notice the absence of one thing here., the absence of bleeding . Even though we are working on the tongue which is just full of blood vessels we have little to no bleeding and these are not touched up photographs one we didn’t blot the tongue just before we made the photographs to impress you. This is the we way it really looked immediately after we removed the papilloma.

 

 

The laser candid, we put socket gel, oral pain gel on top of that and here it is 6 days later and you can see that it has healed up so well .It really a little difficult to even tell where the pap lama was before we took it off. I don’t know if you have this in your   practise, I just want to mention it to you. You can purchase this through Henry Schein dental, it uses The Dental Pie 300, it’s a multi oral cancer screening device. We use it in urn I office it has a wide wave length that just helps to eliminate the mouth. The violet with speckle glasses will show up any kind of legions as a dark spot in the tissue and then you can help to differentiate it by the green amber light and it shows you the vasculature to the area that you are concerned about. A very   concise vasculature probably   means it so and a very diffuse vasculature   is something that concerns.

 

This is a wonderful tool and I know that it goes hand in hand  with laser se and we  use it in our office routinely .We did do  a training  video for them and you can see that at abystintrimera.net.

 

Prenectomies

Again remember every day , very way  dentistry we see people come in all  the time with a Lowe attach  phrenic or a diasoma between  8 and 9 and were phrenectomy  is necessary and remember we see the problem if we have a solution to that  problem . Here’s an ortadontist case, a very; low attached perineum removed with the laser. Again look at we do not see, bleeding. We do a pretty aggressive phenectomy and we have very little bit of bleeding when we do this. Post operatively several weeks after the fact look at what our attachment reoccurred I’m going to show you in the next series of slides how you determine where you can place your reattachment of the phrenic and we can put it exactly where you want it to reattach.

 

Here’s that phrenctomy step by step, also with the distraction of kea legion. Low attach premium again, soft tissue pick up forces in the laser. We do an aggressive phrenectomy. We’re going to take the entire little muscle out. Very little bleeding here. Turn it over and do the other side. Now we’ve removed the perineum and then we go back between the central insiders and actually cleanout. There is always   that little area between the teeth where there is a lot of tissue attachment and the bone just sort of invigilate there. We’re cleaning that out there really good to make sure that we have all the fibres.

 

 

Then a very important step is to score the periostum. The way that we determine how we do that so we look at the junction of the removable and the attached tissue and where we scored the perisotuium there we will have a scar band and that scar band will determine where the phrenum reattaches. If you’ll just lock that in your  in as we got through these remaining slides you wills eye that  the phrenum actually goes back and reattach exactly to that spot.   With these you could probably leave them open. I think we get better healing and also by placing sutures it prevents any kind of reattachment in there of the tissue.

 

 

Now it’s healed up from that but you still see that we have a little legion of here to the right and we will go in and remove this legion using the ablation process. Thad is a chisel tip and instead of sizing it and cutting it out we’re just going to ablate it away.  The tissue is just taken down cell layer by cell layer until it’s gone and here it is a few weeks after that when it is healed up completely. Remember in your mind where we score court pereostum and this is where our attachment will go back to.

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If you didn’t see this wonderful article in Dental Economics recently by Rodger Levin , the march edition I would encourage you to take a  look at that and when you’re  Dental Economic issue  arrives this month be sure  to take a look at our upcoming article, The $250 000 Smoked Ham.  In the article it talks about the fact that we a general dentist refer out of our offices each ear, approximately $250 000 in production that we can do under our roof. It’s not the exotic, its everyday destroy that we are referring. In December the UPS guy comes and brings us that wonderful smoked ham and we are so excited because we have a $95 ham while we spent $250 000 of our practise.

 

I got this information from Charles Blair very recently. There’s 500 dental procedures that you and I do .The referral dentist does only 60 of those 500 procedures.  Joe’s average dentist does 90 of the 500 procedures. The decathlon  dentist does 120 of  those 500 procedures so  what I want  to challenge you to do tonight is  to go back and look at the number of procedures your routinely doing and if you are under that 120 mark by adding a laser into  you practise you can became a decathlon dentist. So you’re training starts today. Also in the Dental Economic the September issue please look at my article don’t be a Sheep. We talk about how to differentiate your practise, how to separate your practise form others. When we come out of dental school sometimes we tend to follow the practise that is right in front of us and we do what they do. Let’s differentiate ourselves and laser is a great way to do that.

 

Perhaps  in the Orthatribune you saw our  article  that talks about how lasers relate  to orthodontist cases and things that we can do and upcoming   in the fall there will  be an article and LVI Vision The impossible is nothing which will cover a lot of the information that we talk k about tight . That was co-authored by Lorne and myself.

 

 

When the lark  goes off in the morning are you really excited to get up and go   to your office air would you rather  just hit the alarm clock like you see in the picture? Do you feel you need direction for you practise? Lasers might just be the driving force that you need. I will honestly tell you that before 1998 when  we purchased out first laser  dentistry  had really become really boring and  I was experiencing   burn out from it , the same thing  all day long , every day .

 

In the 1998  we purchased out first laser which was Boa Lays laser and later on we purchased a Delight and a Versa wave  and then the laser that we  currently use which I think is the finest laser  on the market is the Boa Lady MD Turbo . When you look at this picture GD black just think about all the changes that has occurred in our profession since these days. These are antique pieces that are in our witting area. Things have really come a long way since the old singer sewing machine, foot pedal driven hand pieces and belt driven hand pieces and then along amen air driven high speeds and now the modern appotoires that we have today and we can now take it one step further by the addition of a laser.

 

As we start tonight I want you to open your minds and erase any pre conceived notions you may have about lasers and dentistry whether good or bad. Just open up your mind to the concept tonight. The things that we say here could change your practise forever in fact they can possibly change your life.

 

I want you to differentiate your practise by jumping out of the dental fish bowl, not like every other practise that is out there. We want you to catch the concepts that we will present here and run with them and for those of you that choose to do that the rewards for your effort will be great. During the next 45 minutes we’re going to talk about nothing but lasers and more lasers. Lasers are all about solutions for everyday problems. You knee every day when   you and I go into the office we are faced with one problems after the other, our patients bring us those problems and from those problems we have to be problem solvers, we have to have solutions. One  of the problems we battle each and every day  on almost each and every  patient is bacteria and one of the things  that  you will learn tonight is that  bacteria is every susceptible to laser energy .

 

You just don’t see the problem if you don’t have a solution. What if all you had in your armentary was to set up forces. What would you see on every [patient? Of course you would see extractions but what if you wades a hand piece and then maybe threw in lights and some instruments and some filling material then we can see a lot more problems because we have a lot more solutions. Then if we added an indo cabinet to our raptor now we can actually think about saving teeth by doing root canals. If we added a soft tissue laser, just think of the soft tissue procedures that we can do now. All of a sudden we more problems because we have more solution and ultimately if we added an YSGG laser, an all tissue laser now we can really see solutions to all the problems that priest present to us.

 

Did you know that only 5 % of general dentist routine lead to osseous and soft tissue procedures? Don’t limit your practise. Rumanian chromium YSGG laser is juts the tool kin the dental tool box but what a fantastic tool it really is and who would have thought that you just couldn’t run dental practise without a laser. There are three things that will shut my laser in my office down and one is loss of air, once is loss of vacuum and the other is loss of laser. Our patients are so oriented towards laser that they just would not want to have procedures done without one.

 

Let   look very briefly and I do mean briefly at physics tonight. Abler Einstein certainly understood that the impossible was nothing. He talked about laser mathematically woven before there was laser. The word laser is an acronym for light amplification by stimulated emission of radiation. In the room that you are sitting right now you probably have some lights in, some ordinary visible light that is multiple wave lengths, non-directional and non-focused. With the laser it monochromatic and its collimated and its coherent light. It’s a single wave length of light.

 

The light energy that travels from the laser itself travels  via fibre optic  delivery system to a hand piece and then the   energy is admitted at  the end of a tip .When the laser energy  leaves the tip it comes in contact  with the tooth and it would either  reflect , transmit , hit and scatter or be absorbed  and the thing that you and  I care about the most  is the absorption . The 2780 anatomy of wave length is the peak absorption in water and hydroxyl appetite sow when we aim the laser at the tooth it’s looking for water. In enamel there is 3%-5% water, dentin have has 10% – 12%, carouse has 16%-18%. Maybe sometimes as high as 40%.

 

The more water that the tooth structure has or the tissue or the bone the faster the laser cuts. The more water it has the faster the laser will cut. That’s why soft tissue cuts faster than any other tissues.  When the tip is aimed at the tooth it’s looking for the water molecules. The water molecule that highly absorb that wave length and as it absorbs it expands and eventually that water molecule will explode and when it does it blows off everything that surrounds it.

 

One blast from the laser will leave a crater that’s about 30 – 50 microns deep into his diameter of the tip that was used. Now let’s move unto some cases. Let’s look at operative dentistry. As we go through this bear in mind problems that you see each and every day in your office. Anybody ever see an area like this? Probably saw one today? The carious extends under the tissue, we have to move the tissue back. We can think about electro surge, we can think about retraction cord door we can think about a laser.

 

In this case without any anaesthesia we were able to move the tissue back, access the decay, remove the decay and place the restoration in a dry environment. All without anaesthesia, without packing cord in a comfortable four hour patient.

 

 

Class four

This patient fell on the asphalt in school. You can tell by the asphalt that is still left on the initial edge there. The mother brought this patient in unscheduled and we were able to clean the tooth up, prep it with a laser without anaesthesia and then send the child back to his mom. Unscheduled patient so we sent that  young patient out looking  just like they hid right before the accident and you don’t think we were a hero  that because of what the laser was able to  do for us and for our patient .

 

A class three

Take the amalgam out with a hand piece and turn to the laser for a nice prep. By the way we get a 50% stronger bond when we prep with the laser than we would if we prep with just burg

 

Class ones

We see class ones all day, every day in our practise and it’s so nice to be able to go in and do these without anaesthesia. Our patients really appreciate the fact from allusions such a and they can return to work or school or home without a numb lip.

 

I don’t know how many  of you  may use a diagnodent in your practise  but a diagnose  is also  a laser and its works  wonderfully  hand  in hand with the Boa Lays laser. We like   early detection of the decay. 80% of the decay occurs in in the inclusion surfaces and with visual and bite wing we probably diagnose about 50%.  In our practise anything that measures 20 or above on our diagnodent we fill. We like to fill it early that meets it a lot easier for us to do it without anaesthesia. By the way being even very conservative we do 80% of our restoration without anaesthesia.

 

Class two

When you are working on a class two you make sure you protect the adjacent tooth with the matrix band. This sis showing the Boa Lays turbo hand piece as it preps a class two. We are able to go through and do this without anaesthesia in most cases.

 

Now let’s talk briefly abound indo .Lets start by talking about direct pulp exposure, mixed incision and we receive a direct pull exposure in this case. As all of you know when you get a direct pupil exposure we can do a pulp cap but we usually expect in about 6 months, 12 months it will be going back and then variably do an indo on a tooth like that.  With laser we can treat a direct pulp exposure a little differently. When we get the red pinpoint we can tune it brown using the laser. What this does is to sterilise the environment.  Then we can place on top of that some MTA and then   go ahead and place our restoration. You can see in the radiograph how deep the restoration was that we placed here. This has been two to three years now, post operatively and the tooth is doing very well.

 

Now why if we get a  pulp exposure  and we treat it with a laser is that going to be different than what we’ve  done in the past .When we get the mechanical  exposure we have no way of getting rid of the bacteria. Remember we talked about it in the beginning that lasers are problem solvers and so with the laser we can actually sterilise that environment before we seal it up with our restoration. That h why we see almost assuredly when we do a pulp exposure we will see success.



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